Date of Graduation

Summer 8-9-2017

Document Type

Project/Capstone

Degree Name

Master of Science in Nursing (MSN)

College/School

School of Nursing and Health Professions

First Advisor

Nancy Taquino, DNP, CNL

Abstract

Title: Standardizing the Bedside Shift Report Process to Improve Communication and Promote Patient Safety.

Author: Gilbert Young, RN, BSN

Setting: Unit 1 North is a 32-bed cardiovascular specialty unit that specializes in the care of post-cardiac surgery and complex telemetry patients. The typical length of stay is between 5-7 days. Patients are admitted to the unit from the ICU, ED, or other medical facility for cardiac surgery.

Rationale: The quality gaps are nurse communication HCAHPS scores not being consistent with performance goals, the unit had 16 documented patient falls in 2016, and patient surveys and staff handoff observations supported the need for this project. The project aim is to (1) improve nurse communication, (2) increase the nurses’ consistency and satisfaction with handoff (3) implement the clinical report tool, and (4) reduce patient falls by 25% on cardiovascular specialty unit by August 2017.

Return on Investment: Reducing four patient falls or 25% of last year’s total will be an annual cost avoidance of $120,000 once this performance improvement plan is implemented. The initial annual savings is estimated at $110,300

Literature Review: The studies assert the importance of bedside report as a means to include the patient, eliminate information gaps, visualize the patient and surroundings for patient safety, and improve team communication. Additional studies examined the use of a standardized nursing handoff tool and saw improvement in patient satisfaction and a reduction in nursing errors.

Methodology: Institute of Healthcare Improvement model for improvement and Lewin’s change management model. Collaborated with unit council to develop clinical handoff tool. Educational plan includes PowerPoint presentation and simulation sessions. Project implemented in February 2017 and guided by PDSA (plan-do-study-act) cycle. Nurse leaders to observe use of clinical handoff tool during shift handoff.

Results: Since implementation in February, average daily census of 32 patients and averaged 66 survey responses each month. Nurse communication scores have been consistently 4 Stars since implementation of this QI project. Current HCAHPS scores up to May 2017. There was a 12.5% reduction in patient falls compared to the same time period last year. Nurse leader observation of NKE using the handoff competency checklist demonstrated successful use of the handoff tool by all nurses, including remediation for some staff. Patient and staff surveys revealed positive improvements in seeking patient input and staff experiencing more satisfaction with the quality if information they receive at shift handoff.

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